Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil

Raphaela Farias Teixeira; Cinthia Maria Costa; Catarina Maria de Abreu; Cicero Amsterdan Lessa; Aline Carla Carvalho; Samir Buainain Kassar; Ikaro Daniel Barreto; Ricardo Queiroz Gurgel; Andrea Monteiro Medeiros

doi:10.1515/jpm-2020-0313

Article

Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil

Raphaela Farias Teixeira , Cinthia Maria Costa , Catarina Maria de Abreu , Cicero Amsterdan Lessa , Aline Carla Carvalho , Samir Buainain Kassar , Ikaro Daniel Barreto , Ricardo Queiroz Gurgel and Andrea Monteiro Medeiros

Published/Copyright: December 18, 2020

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From the journal Journal of Perinatal Medicine Volume 49 Issue 4

Abstract

Objectives

Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants.

Methods

A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model.

Results

Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26–18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables.

Conclusions

Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.

Keywords: airway extubation; critical care outcomes; respiration artificial; risk factors; very low birth weight infant

Corresponding author: Raphaela Farias Teixeira, Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; CESMAC University Centre, Maceió, Alagoas, Brazil; and Santa Monica Maternity School Hospital, Maceió, Alagoas, Brazil, E-mail: ftraphaelafarias@hotmail.com

Funding source: Scientific Initiation Seed Program at Cesmac University Center – SANTANDER

Award Identifier / Grant number: 2018–2019

Research funding: This work was supported by the Scientific Initiation Seed Program at Cesmac University Center – SANTANDER under grant 2018–2019.
Author contributions: RFT, CMC, CMA and CAL collected the data and wrote the first draft of the paper. RFT, ACC and IDB analyzed the data. ACC, SBK, RQG and AMM contributed in writing the paper and providing critical feedback. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: No potential conflicts of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the human research Ethics Committee of CESMAC Centre University (report #2.555.319/2018), and all parents agreed to sign an informed consent form.

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Received: 2020-07-13

Accepted: 2020-12-06

Published Online: 2020-12-18

Published in Print: 2021-05-26

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https://doi.org/10.1515/jpm-2020-0313

Keywords for this article

airway extubation; critical care outcomes; respiration artificial; risk factors; very low birth weight infant